Canada: “prisoners' health is public health”

The Canadian HIV/AIDS Legal Network. From the organization’s inception more than two decades ago, we have observed alarmingly high rates of HIV and hepatitis C in prison. These are a result of the high numbers of people who use drugs in prison, many of whom are living with HIV and hepatitis. We also identified these to be a consequence of the discriminatory lack of access to key harm reduction measures behind bars, including needle and syringe programs, opioid substitution therapy, and safer tattooing programs.

It was vital for us to advocate for an access to healthcare in prison equivalent to that granted outside and to challenge the discourse that prisoners should surrender their right to health when they are incarcerated.

While people who use drugs already face stigma and discrimination in the community, this is decidedly amplified in prison settings. Convincing policymakers, politicians, courts and the public as a whole that prisoners’ health is public health has been an uphill battle.

The Legal Network. Canada’s prison system is divided between federal prisons (where people serve a sentence of 2 or more years) and provincial prisons (where people serve sentences shorter than 2 years).
Federal prisons are run by the federal correctional service. On paper, they offer condoms, dental dams, lubricant, bleach to sterilize injection equipment, opioid substitution therapy, HIV and hepatitis C treatment and naloxone¹.

In practice, prisoners have described poor access and, in some cases, long waiting lists for treatment. For example, in spite of the increasing frequency of opioid overdoses behind bars, prisoners do not have direct access to naloxone and this treatment can only be administered by staff.

A few years ago, the Canadian HIV/AIDS Legal Network spearheaded a court case challenging the federal government’s denial of needle and syringe programs to prisoners. As a result, a handful of federal prisons now also offer prison-based needle and syringe programs. However, access is highly restricted and the program model is fundamentally flawed. To address these flaws and to ensure that prisoners’ right to needle and syringe programs is entrenched in law, we are continuing our lawsuit. In 2019, one federal prison introduced a supervised consumption site.

Provincial prisons vary in the harm reduction programs they offer. Most offer HIV and hepatitis C treatment and condoms. Many also offer opioid substitution therapy. And while an increasing number of provincial prisons are equipping correctional staff with naloxone, none of these facilities provide needle and syringe programs.

The Legal Network. The most interesting program we have uncovered in relation to prison-based needle and syringe programs is Moldova’s peer distribution model. In this program, “peers” (i.e. prisoners) are trained in harm reduction and help distribute sterile injection equipment to fellow prisoners. Confidentiality under this model is preserved and uptake has been high, without any corresponding increase in security incidents or in drug use.

Canada is also unique in having piloted the world’s first “safer tattooing” project in federal prisons in 2005.

Evaluations of the program were largely positive, but it was cancelled after the election of a conservative federal government that campaigned on a “law and order” agenda. This program is worth resurrecting in Canada and elsewhere in the world.